Surgical intervention is the primary and only curative treatment for cholesteatoma NICE CKS. The extent of the cholesteatoma lesion determines the specific type of surgery required NICE CKS. For instance, mastoidectomy may be necessary if there is extensive disease NICE CKS.
Urgent surgical intervention is indicated in patients presenting with suspected cholesteatoma who also exhibit signs of serious or life-threatening complications NICE CKS. These include an associated facial nerve palsy, neurological symptoms or signs, or if the patient is systemically unwell, as these may suggest more extensive or advanced disease NICE CKS. Clinical features indicative of complications such as acute mastoiditis, intracranial abscess, or meningitis also necessitate urgent hospital admission or specialist ENT advice, often leading to surgical management NICE CKS. Delayed treatment in cases with facial nerve palsy is associated with a poor prognosis NICE CKS.
For all patients diagnosed with cholesteatoma, prompt referral to an Ear, Nose, and Throat (ENT) specialist is arranged for further assessment, confirmation of the diagnosis, and consideration of surgical intervention NICE CKS. High-resolution CT imaging of the temporal bone is often used to define the extent of the cholesteatoma, identify bony erosion, and assess for other complications, which guides surgical planning NICE CKS. Endoscopic management is also a recognized surgical approach for primary acquired cholesteatoma Chiao et al. 2021.
Key References
- CKS - Cholesteatoma
- CKS - Otitis media - chronic suppurative
- CKS - Otitis externa
- NG233 - Otitis media with effusion in under 12s
- NG98 - Hearing loss in adults: assessment and management
- (Sheehy, 1989): Acquired cholesteatoma in adults.
- (Chiao et al., 2021): Endoscopic Management of Primary Acquired Cholesteatoma.